title: Chest radiography for predicting the cause of febrile illness among inpatients in Moshi, Tanzania.
abstract: OBJECTIVE
  To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting.
  
  
  METHODS
  Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of fever.
  
  
  RESULTS
  Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adolescents and adults, the remainder were infants and children. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adolescents and adults, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii, whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans.
  
  
  CONCLUSIONS
  Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing an aetiologic diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Fiorillo
authors.forename: H C
authors.initials: HC
authors.lastname: Diefenthal
authors.forename: P C
authors.initials: PC
authors.lastname: Goodman
authors.forename: H O
authors.initials: HO
authors.lastname: Ramadhani
authors.forename: B N
authors.initials: BN
authors.lastname: Njau
authors.forename: A B
authors.initials: AB
authors.lastname: Morrissey
authors.forename: V P
authors.initials: VP
authors.lastname: Maro
authors.forename: W
authors.initials: W
authors.lastname: Saganda
authors.forename: G D
authors.initials: GD
authors.lastname: Kinabo
authors.forename: M S
authors.initials: MS
authors.lastname: Mwako
authors.forename: J A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: J A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000000981:diagnostic imaging*; D011008:Pneumococcal Infections / Q000150:complications* / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011778:Q Fever / Q000150:complications* / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods*; D013636:Tanzania